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22-09-2012

Ïðîñòàòè÷åñêàÿ êèñëàÿ ôîñôàòàçà

 

Ââåäåíèå

Êèñëàÿ ôîñôàòàçà – ýòî ãðóïïà èçîôåðìåíòîâ, êîòîðûå ðàçäåëÿþòñÿ ïî èõ ýëåêòðîôîðåòè÷åñêîé ïîäâèæíîñòè. Êèñëàÿ ôîñôàòàçà êàòàëèçèðóåò ãèäðîëèç ñëîæíûõ ýôèðîâ ôîñôîðíîé êèñëîòû è îðãàíè÷åñêèõ ñîåäèíåíèé. Ýòîò ëèçîñîìàëüíûé ôåðìåíò ñîäåðæèòñÿ ïðàêòè÷åñêè âî âñåõ òêàíÿõ. Ñàìàÿ âûñîêàÿ êîíöåíòðàöèÿ îòìå÷àåòñÿ â ïðåäñòàòåëüíîé æåëåçå (ïðîñòàòè÷åñêàÿ ôðàêöèÿ), çàòåì - â ïå÷åíè, ñåëåçåíêå, ýðèòðîöèòàõ (âíåëèçîñîìàëüíàÿ ëîêàëèçàöèÿ), òðîìáîöèòàõ, êîñòíîì ìîçãå. Âûñîêàÿ àêòèâíîñòü êèñëîé ôîñôàòàçû îòìå÷àåòñÿ â ìàêðîôàãàõ è îñòåîêëàñòàõ. Àêòèâíîñòü êèñëîé ôîñôàòàçû ïðåäñòàòåëüíîé æåëåçû íèêàê íå ïðîÿâëÿåòñÿ âïëîòü äî äîñòèæåíèÿ ïîëîâîé çðåëîñòè. Ó ìóæ÷èí îáùàÿ êèñëàÿ ôîñôàòàçà ñûâîðîòêè ñîñòîèò èç ïðîñòàòè÷åñêîé êèñëîé ôîñôàòàçû (PAP), è, ÷àñòè÷íî, êèñëîé ôîñôàòàçû ïå÷åíè è êèñëîé ôîñôàòàçû, âûøåäøåé èç ðàçðóøåííûõ òðîìáîöèòîâ è ýðèòðîöèòîâ. Ó æåíùèí âûÿâëÿåòñÿ ïðåèìóùåñòâåííî ïå÷åíî÷íîå, ýðèòðîöèòàðíîå è òðîìáîöèòàðíîå ïðîèñõîæäåíèå ôåðìåíòà â ñûâîðîòêå êðîâè.

Äèàãíîñòè÷åñêîå çíà÷åíèå

Ïðîñòàòè÷åñêàÿ êèñëàÿ ôîñôàòàçà (PAP) ÿâëÿåòñÿ èçîôåðìåíòîì êèñëîé ôîñôàòàçû. Ñàìîé áîëüøîé ôðàêöèåé PAP ÿâëÿåòñÿ èçîôåðìåíò-2, êîòîðûé ïðåäñòàâëÿåò ñîáîé ãëèêîïðîòåèí ìîëåêóëÿðíîé ìàññîé 100 êÄà (2,3).  ïðåäñòàòåëüíîé æåëåçå êèñëàÿ ôîñôàòàçà îáíàðóæåíà â áîëüøîé êîíöåíòðàöèè (4).  ñûâîðîòêå êðîâè âûÿâëÿþòñÿ èçîôåðìåíòû êèñëîé ôîñôàòàçû, ñïåöèôè÷íûå äëÿ ðàçëè÷íûõ òèïîâ òêàíåé (1,5,6,7). PAP – îäèí èç êîìïîíåíòîâ ñåìåííîé æèäêîñòè, îí ñåêðåòèðóåòñÿ òàêæå è â ìî÷ó.  íîðìå â ñûâîðîòêå êðîâè PAP ïðèñóòñòâóåò â íèçêèõ êîíöåíòðàöèÿõ. Àêòèâíîñòü ïðîñòàòè÷åñêîé ôðàêöèè ôåðìåíòà èíãèáèðóþò òàðòðàò, îêñàëàò, èîíû ôòîðà è æåëåçà. Óñòîé÷èâûå ê äåéñòâèþ òàðòðàòà ôîðìû êèñëîé ôîñôàòàçû èìåþò èñòî÷íèêîì äðóãèå îðãàíû è òêàíè (1).

Ïîâûøåíèå êîíöåíòðàöèè êèñëîé ôîñôàòàçû â êðîâè ïàöèåíòîâ ñ äèññåìèíèðîâàííûì ðàêîì ïðåäñòàòåëüíîé æåëåçû âïåðâûå áûëî îïèñàíî â 1938 ãîäó Gutman è ñîàâòîðàìè (8). Ïîçæå áûëî ïîêàçàíî, ÷òî ïîâûøåííûé óðîâåíü PAP â êðîâè êîððåëèðóåò ñî ñòàäèåé ðàêà ïðåäñòàòåëüíîé æåëåçû (9-12). Òàêèì îáðàçîì, îïðåäåëåíèå PAP ìîæíî èñïîëüçîâàòü äëÿ ïîäòâåðæäåíèÿ êëèíè÷åñêîé ñòàäèè ðàêà ïðåäñòàòåëüíîé æåëåçû (13).

Ýòîò ìàðêåð òàêæå èñïîëüçóþò â êà÷åñòâå âñïîìîãàòåëüíîãî òåñòà ïðè ìîíèòîðèíãå ïàöèåíòîâ ñ ðàêîì ïðîñòàòû (13,14). Äàííûé òåñò èìååò áîëüøîå çíà÷åíèå äëÿ îöåíêè ïðîãíîçà çàáîëåâàíèÿ (äîñòèæåíèÿ ðåìèññèè è âîçìîæíîñòü ðåöèäèâà), (3,15,16), à òàêæå ýôôåêòèâíîñòè ïðîâîäèìîé òåðàïèè (17,18). Ïîñëå óñïåøíîé òåðàïèè íàáëþäàåòñÿ íîðìàëèçàöèÿ PAP â êðîâè (13,17,18).

Ïîêàçàíèÿ ê íàçíà÷åíèþ èññëåäîâàíèÿ:

  • Çàáîëåâàíèÿ ïðåäñòàòåëüíîé æåëåçû (ìîíèòîðèíã òå÷åíèÿ êàðöèíîìû ïðîñòàòû)
  • Çàáîëåâàíèÿ ïå÷åíè, ïî÷åê

Ïîâûøåíèå êîíöåíòðàöèè PAP â ñûâîðîòêå êðîâè âûÿâëÿåòñÿ ïðè ñëåäóþùèõ çàáîëåâàíèÿõ è ñîñòîÿíèÿõ:

  • Ðàê ïðåäñòàòåëüíîé æåëåçû
  • Ðàê ïðåäñòàòåëüíîé æåëåçû, êîòîðûé ðàñïðîñòðàíèëñÿ çà ïðåäåëû ïðåäñòàòåëüíîé æåëåçû (â ÷àñòíîñòè, êîñòü)
  • Ñîêðàùåíèå ïðèòîêà êðîâè ê ïðåäñòàòåëüíîé æåëåçû
  • Áîëåçíü Ïåäæåòà
  • Àíåìèÿ
  • Èíôåêöèè (êàê ïðàâèëî, îñòðûå âèðóñíûå èíôåêöèè)
  • Òðîìáîôëåáèò
  • Áîëåçíü Ãîøå
  • Ãèïåðïàðàòèðåîèäèçì
  • Ïðèñòóï ñòåíîêàðäèè
  • Ïîñëå ìåäèöèíñêèõ ïðîöåäóð (êîëîíîñêîïèÿ, êëèçìû, ìàññàæ ïðîñòàòû)
  • Ìíîæåñòâåííàÿ ìèåëîìà
  • Ïðîñòàòèò

Êîìïëåêñ ëàáîðàòîðíûõ òåñòîâ äëÿ äèàãíîñòèêè çàáîëåâàíèé ïðîñòàòè÷åñêîé æåëåçû:

  • Îáùèé àíàëèç ìî÷è
  • Îáùåêëèíè÷åñêîå èññëåäîâàíèå ñåêðåòà ïðåäñòàòåëüíîé æåëåçû
  • Êèñëàÿ ôîñôàòàçà
  • Ïðîñòàòè÷åñêàÿ êèñëàÿ ôîñôàòàçà (PAP)
  • ÏÑÀ (ïðîñòàòè÷åñêèé ñïåöèôè÷åñêèé àíòèãåí) îáùèé
  • ÏÑÀ (ïðîñòàòè÷åñêèé ñïåöèôè÷åñêèé àíòèãåí) ñâîáîäíûé

Ëèòåðàòóðà 

1. Yam LT. Clinical significance of human acid phosphatases – a review. Amer J Med 1974; 56:604-16.

2. Derechin M, Ostrowski W, Galka M, Barnard E. Acid phosphomoesterase of human prostate molecular weight, dissociation and chemical composition. Biochim Biophys Acta 1971; 250:143-54.

3. Choe B, Pontes E, McDonald I, Rose NR. Immunochemical studies of prostatic acid phosphatase. Cancer Treat Rep 1977; 61:201-04.

4. Kutscher W, Wolbergs H. Prostataphosphatase. Zeitschrift fur Physiol Chem 1935; 236:237.

5. Murphy G, et al. CA 1978; 28:258.

6. Cooper J, Foti A, Shank P. Radioimmunochemical measurement of bone marrow prostatic acid phospatase. J Urol 1978; 119:392-95.

7. Rose N, et al. Lab Management 1978; 16:31.

8. Gutman A, Gutman E. An 'acid' phosphatase occuring in the serum of patients with metastasizing carcinoma of the prostate gland. J Clin Invest 1938; 297:473-78.

9. Foti A, Cooper J, Herschman H, Malvaez R. Detection of prostatic cancer by solid-phase radioimmunoassay of serum prostatic acid phosphatase. N Engl J Med 1977; 297:1357-61.

10. Mahan D, Doctor B. A radioimmunoassay for human prostatic acid phospatase levels in prostatic disease. Clin Biochem 1979; 12:10-17.

11. Pontes J, Choe B, Rose N, Ercole C, Pierce J. Clinical evaluation of immunological methods for detection of serum prostatic acid phosphatase. J Urol 1981; 126:363-65.

12. Chu T. Serum acid phosphohydrolase (phosphatase) and ribonuclease in diagnosis of prostatic cancer. Antibiot Chemother 1978; 22:98-104.

13. Pappas A, Gadsen H. Prostatic acid phosphatase: clinical utility in detection, assessment and monitoring carcinoma of the prostate. Ann Clin Lab Sci 1984; 14:285-90.

14. Vihko P, Lukkarinen O, Kontturi M, Vihko R. Effectiveness of radioimmunoassay of human prostatic-specific acid phosphatase in diagnosis and follow-up of therapy in prostatic cancer. Cancer Res 1981; 41:1180-83.

15. Wajsman Z, Chu T. Detection and diagnosis of prostatic cancer. In: Prostatic Cancer. G.P. Murphy, ed. Littleton, MA: PSG Publishing, 1979: 111-28.

16. Chu T, Wang M, Kuciel R, Valenzuela L, Murphy G. Enzyme markers in human prostatic cancer. Cancer Treat Rep 1977; 61:193-200.

17. Chu T, et al. Tumor antigen and acid phosphatase isoenzymes in prostatic cancer. Cancer Chemother Rep 1975; 59:97-103.

18. Johnson D, et al. Clinical significance of serum acid phosphatase levels in prostatic carcinoma. Urology 1976; 8:123-26.